General Internal Medicine, Palliative Medicine & Medical Education

► Interdisciplinary Palliative Care Education Project

This five year project funded by the National Institutes of Health/National Cancer Institute in Fall 2010 will design, implement and evaluate an innovative, integrated, and interdisciplinary oncology palliative care curriculum for medical, nursing, social work and chaplaincy students.

Specific aims are to: 1) design an innovative, interdisciplinary oncology palliative care curriculum; 2) implement the interdisciplinary oncology palliative care curriculum; 3) develop and utilize an evaluation system that measures the effectiveness of the curriculum, learner outcomes, and the long term impact on practitioners and patients. (Pfeifer, Holthouser, Shaw, Head, Greenberg, Earnshaw, Simons, Mandrola, Keeney, and Scharfenberger)

► Job Satisfaction and Attitudes towards Specialty Certification among Hospice and Palliative Nursing Assistants

Funded by the Hospice and Palliative Nurses Foundation in September, 2010, this study is conducting a nationwide survey of hospice and palliative nursing assistants. This group of nursing assistants is the only one to have a specialty certification program. The study will evaluate the job satisfaction of these nursing assistants and compare them with nursing assistants working in other venues, and will compare their attitudes towards specialty certification to those of registered nurses. (Head)

► Aggressive Symptom Management in Lung Cancer Patients Using a Telehealth Device

Funded by the Commonwealth of Kentucky Lung Cancer Research Program for 2008-2011, this study is focused on developing and testing a telehealth-based psychoeducational program for lung cancer patients.

The goal is to improve symptom management and quality of life during initial treatment for patients with advanced lung cancer undergoing treatment. (Pfeifer, Head, Keeney, Scharfenberger)

► The Effects of Motivational Interviewing on Type 2 Diabetes Mellitus in African American Adults:  A Pilot Study

Funded by Passport Health Plan’s Improved Health Outcomes Project for 2009-2010, this study will be conducting a randomized clinical trial to determine the effect of a motivational interviewing (MI) intervention on adherence to prescribed treatment regimens, diabetes markers, and number of unscheduled health care visits among African Americans with Type 2 DM. The usual care group participants will receive the standard care provided at the clinic site, while the motivational interviewing intervention will address medication usage, blood glucose monitoring, and physical activity. The MI process includes strategies to build rapport, evaluate current level of adherence to each of the targeted behaviors, assess the importance that participants assign to the behavior changes, assess confidence in their ability to change the behaviors, and explore costs and benefits of changing the behaviors. As participants progress to the preparation stage of behavioral change, the interventionist and participant will collaboratively begin to devise a plan for achieving behavior change goals. Diabetes markers will be measured, including HbA1c, fasting serum glucose, and body composition. Measurements of body composition will be obtained by research staff, and the physical activity data will be downloaded from activity monitors. (Kubiak)

► Assessment of Asthma Control in a Low-Income Internal Medicine Residency Clinic

Funded by Passport Health Plan for 2010, the Asthma Control Test (ACT) has been proven to be a valid, reliable tool in assessing patients’ symptoms and identifying poorly controlled asthma. We are interested in symptom control in the primary care population, particularly the low income population. This study aims to determine the best way to administer the Asthma Control Test (ACT):  to mail in a survey or administer in an office setting. In addition, we are comparing the validated children's ACT to the adult version to give us an idea if health illiteracy accounted for some of the lack of effect in a prior study of Medicaid patients. Finally, we are looking to see if patients that have the ACT administered have better asthma care as shown by decreased, self-reported hospitalizations, ER/urgent care visits, or by changes in pharmacological management. (Mitchell, Kubiak, Rose, Pyle)

► Integrated Didactic and Experiential Palliative Care Curriculum Project

This program was funded by a grant from the Medical School of Wisconsin’s EPERC project, with funding from the Robert Wood Johnson Foundation. The goal of this project was to create a longitudinal palliative care curriculum for all four years of medical training at the U of L School of Medicine. Project efforts included integrating palliative care content into existing first and second year courses; the creation and implementation of a required one-week clinical rotation for third year medical students that includes web-based self-study modules addressing core palliative care concepts; a clinical vignette; and the creation of an elective 2 or 4 week palliative care clinical rotation offered to fourth year medical students.

Results for 3rd year students who completed the required palliative medicine clinical rotation academic year 2008-2009 indicate significant improvement in palliative care knowledge test scores and significantly higher levels of confidence and competence in palliative medicine related skills when compared to students from the academic year 2007-2008 who did not complete a palliative care rotation. Results have been presented at the Alliance for Academic Medicine Annual Meeting in 2008, AAMC: Southern Group on Educational Affairs Annual Meeting in 2009, and at the annual meeting of the American Academy of Hospice and Palliative Medicine in 2010.  (Shaw, Holthouser, Pfeifer, Greenberg, Head, Scharfenberger)

► An Exploratory Study of the Experience and Needs of Medicaid Recipients with Advanced Cancer

Funded by the University of Louisville’s Commission on Diversity and Racial Equality and Passport Health Plan, this qualitative study analyzed intensive interviews with 10 patients receiving Medicaid to evaluate their experiences with the health care system.

Results were presented at the 2009 annual meeting of the American Psychosocial Oncology Society and will be presented at the 2011 annual meeting of the American Academy of Hospice and Palliative Medicine.  (Head and Schapmire)

► Telehealth Symptom Management in Head and Neck Cancer

Funded by the National Cancer Institute, this recently completed randomized controlled trial developed and tested a telehealth intervention to improve symptom management and quality of life in patients undergoing treatment for head and neck cancers. Results indicate a significant difference in quality of life after treatment of patients in the treatment vs. control group. The intervention was found to be feasible and well-accepted by the treatment group and clinical staff. Results have been presented at the NCI (September 2008), the Supportive Oncology Conference (October 2008), the American Psychosocial Oncology Society’s Annual Meeting (February 2009), the Oncology Nursing Society’s Research Conference (February 2009) and the annual meeting of the American Academy of Hospice and Palliative Medicine (March 2009). Results of the study have been published in Telemedicine and e-Health and will appear in the Journal of Supportive Oncology in January 2011. (Pfeifer, Head, Keeney, Scharfenberger)

► End of Life Nursing Education Consortium (ELNEC) – Geriatric Program

Dr. Head served as faculty on this project which is co-sponsored by the American Association of Colleges of Nursing and the City of Hope and is headed by Betty Ferrell, Ph.D. The goal of this project is to educate geriatric nurses in the principles and practices of interdisciplinary end-of-life care. The course is offered nationwide and internationally.

Cynthia Keeney has also been completed ELNEC and is a certified trainer. (Head)

► Decision Case Method Teaching for Social Workers and Nurses

Dr. Head participated in a Soros Foundation funded Project on Death in America study headed by Terry Wolfer, PhD. This project developed decision cases to be used to develop social workers clinical practice skills with dying patients and bereaved survivors. Dr. Head helped recruit cases from practicing social workers, interviewed social workers, and wrote two cases published in the final product. Subsequently, she received the U of L’s Paul Webber Teaching Award and was funded to work with senior nursing students to recruit and develop decision cases. Sixty cases were developed, many of which deal with palliative care and oncology scenarios. An article was published on Decision Case Method in the Journal of Social Work in End-of-Life & Palliative Care in 2008, and an article on the nursing project is undergoing final revisions for publication. (Head)

► Socioeconomic Well-Being in Oncology

For her dissertation, Dr. Head developed and validated a quality of life scale measuring socioeconomic well-being in patients with a cancer diagnosis.

She published her results in Supportive Oncology in April 2008. (Head)